Institution: Manchester University

XXX
Student:

Preceptor: Jason Isch

Site: St Joseph Regional Medical Center Family Medicine Center
Date:
Type: PHRM 630 APPE Ambulatory Care (Family Medicine (DPC))

APPE DPC Evaluation (Midpoint & Final)

General overview

This document and its contents are protected by the Family Educational Rights and Privacy Act (FERPA), which
prohibits the disclosure of students’ educational information to individuals who do not have a legitimate educational
purpose in receiving such information. This form and its contents shall not be disclosed to any person or entity other
than the student or the Office of Experiential Education of Manchester University Pharmacy program.

How to apply scoring

For Section 1 (Patient Care Provider Domain – Self-Developer Domain):

Exceeds Expectations: Ready for supervision at a distance. I trust the learner to completely and accurately….

Meets Expectations: Ready for reactive supervision. I trust the learner, with limited correction, to….

Below Expectations: Ready for direct, proactive supervision. I trust the learner, with direct supervision and
frequent correction, to….

Fail: I do not trust the learner to…

Section Weight: 0%

Patient Care Provider Domain MIDPOINT FINAL

Collect information to identify a patient’s Meets – Student is efficient and Meets – Student continues to be
medication-related problems and health-related thorough. He is learning to dig efficient and thorough. He is
needs. deeper in the chart (especially navigating the EMR with more
in HF clinic) to gather ease.
information that can be used to
Question Comments Question Comments assess the patient’s current
(Midpoint): (Final): treatment plan and to identify
gaps/inappropriate therapies.

Identify medication related problems. Meets – Student is passionate Meets – see midpoint
about identifying problems comments
and/or identifying interventions
Question Comments Question Comments that could provide greater
(Midpoint): (Final): benefit for the patient.

Compile a prioritized health-related problem list Meets – Like all students on an
for a patient. ambulatory care rotation, he
wants to address all concerns of
a patient, but he is able to
Question Comments Question Comments appropriately prioritize based
(Midpoint): (Final): on the chief complaint and the
Meets – Student makes sure to
address all concerns of a patient
and appropriately refers to other
providers if it is beyond the
scope of the visit/practice. For
example, there was a patient in
 purpose of the visit.
Evaluate an existing drug therapy regimen for Meets – Student is familiar with Meets – see midpoint
its effectiveness. treatment goals and can
estimate if current therapy plans
may/may not get patients to
Question Comments Question Comments goal. He has solid baseline
(Midpoint): (Final): knowledge of the efficacy of
diabetes medications, in
particular.
Develop an evidence-based treatment plan for Meets – Student often
a patient. references guidelines and
makes treatment plans based on
first-line therapies. He can
Question Comments Question Comments continue to work on
(Midpoint): (Final): individualizing therapy based
on patient-specific parameters.
Collaborate with the patient, caregiver(s) and Below/Meets – Student is goal-
other health professionals to establish patient- driven, caring, enthusiastic, and
centered goals. matter-of-fact. We will work on
bringing the patient into the
treatment plan, especially when
Question Comments Question Comments they may be hesitant or
(Midpoint): (Final): skeptical of our
recommendations.
Implement a treatment plan in collaboration with Below/Meets – In HF clinic, Below/Meets – Student is
other health professionals. Student worked effectively with confident and outspoken in his
the cardiologist to develop
treatment plans. We discussed
Question Comments Question Comments the importance of developing
(Midpoint): (Final): respectful and productive
relationships, even when
opinions may differ slightly on
the plan.
Educate a patient and caregiver(s) in the Meets – On multiple occasions,
implementation of their treatment plan. Student has educated patients
(Examples – medications, devices, etc.) on changes to therapy, insulin
pens, CGMS, etc. He identifies
that he sometimes uses
Question Comments Question Comments “medical jargon” but he is
(Midpoint): (Final): actively working on teaching to
the patient in front of him.
DM clinic who was struggling
with constipation and burning
from a nicotine patch. Although
the appointment was for DM,
Student provided
recommendations and
counseling to address his
concerns.
comments
Meets – Student has integrated
patient-specific factors into his
treatment plans and this will be
a continual focus if he decides
to pursue ambulatory care in
the future.
Below/Meets – Student has
worked to incorporate patient
preferences and can continue to
work on reflecting/mirroring
patients’ concerns and on
motivational interviewing. As
providers, we often have to
meet patients where they are
and walk alongside them to get
them to goals.
recommendations. He is often
on the right track but can
continue to work on
incorporating perspectives and
experiences of other providers.
There is always something to
learn!
Meets – Can continue to work
on using patient-friendly
language, but he is detailed and
thorough in his explanations.
Assess patient adherence to the treatment plan Meets – When Student Meets – successfully performed
and assist with behavior change as needed. performs med recs, he is multiple medication adherence
thorough and assess their PDC calls and solved issues where
to deepen the discussion. He they arose.
Question Comments Question Comments has and will perform more
(Midpoint): (Final): medication adherence calls and
suggest solutions for
nonadherence.

Recommend modifications or adjustments to an Meets – Student has been able Meets – Student provides
existing medication therapy regimen based on to identify when patients are thoughtful recommendations
patient response. not responding to therapy as for adjustments, he can work on
expected and has helped decide providing explanation of his
next steps. For example, we had decisions/thought process when
Question Comments Question Comments a patient on Trulicity who had presenting a patient to a
(Midpoint): (Final): not lost much weight nor had preceptor.
much BG lowering, so we
decided we would try to switch
them to Mounjaro to see if there
was additional benefit before
adding other agents.

Assist in a patient’s transition to different
level(s) of care or care setting(s). (Example -
admission or discharge from a hospital or
nursing facility or transfer to a different level of
care within the same facility)
Question Comments Question Comments
(Midpoint): (Final):
N/A – Student is eager to
participate in TOC. We have
not yet had the opportunity, but
I anticipate that it will come in
the next couple of weeks and
expect that he will be thorough
and efficient like usual.
N/A – the opportunity did not
arise to assess this directly, but
Student has shown he can work
up all of a patient’s problems
and address them clearly and
with organization.

Section Weight: 0%

Interprofessional Team
Member Domain MIDPOINT
Collaborate as the medication expert as part of Meets - In HF clinic, Student
an interprofessional team. worked effectively with the
cardiologist and reviewed notes
from nephrologists to develop
Question Comments Question Comments treatment plans. We discussed
(Midpoint): (Final): the importance of developing
respectful and productive
relationships, even when
opinions may differ slightly on
the plan.
FINAL
Meets – Student is an engaged
expert. He makes strong
recommendations with clear
reasoning. He can continue to
work on his approach to
presenting treatment plans to
other providers.

Section Weight: 0%

Population Health Promoter

Domain MIDPOINT FINAL
Review and document adverse drug events and N/A N/A
medication errors within a medication use
system.
Question Comments Question Comments
(Midpoint): (Final):
Determine CDC-recommended immunizations
for a specific patient, then administer and
document as applicable.
Question Comments Question Comments
(Midpoint): (Final):
Information Master Domain
Educate professional colleagues or lay
audience(s) based on the evaluation of
scientific literature and its application.
Question Comments Question Comments
(Midpoint): (Final):
Use setting appropriate verbal communication
skills.
Question Comments Question Comments
(Midpoint): (Final):
Use setting appropriate written communication
skills.
Question Comments Question Comments
(Midpoint): (Final):
Retrieve and analyze scientific literature to Meets – Student is quick to go
make a patient-specific recommendation and/or searching for answers and uses
answer a drug information question.
Question Comments Question Comments
(Midpoint): (Final):
Meets – Student is familiar with Meets – see midpoint
vaccine recommendations but
took it upon himself to become
even more familiar with billing
restrictions for HepB
specifically.
MIDPOINT
N/A – Student will do a patient
case presentation in the second
half of this rotation.
Meets – Student has identified
that he is often eager to jump
into conversation and offer
input, but he making an effort
to intentionally listen and
observe more. He is able to
build rapport with patients
especially and shows them with
body language and words alike
that he is invested in their care.
Meets – Student has started
documenting patient encounters
and is succinct. We will focus
on separating subjective
information from
assessment/plan in HF clinic.
appropriate sources. He is able
to analyze if results are
statistically significant and/or
clinically significant.
comments
Section Weight: 0%
FINAL
Exceeds – Student’s patient
case presentation was standout.
He assessed literature
appropriately to inform his final
recommendation. He was an
engaging teacher as well and
actively incorporated the
audience into his teaching
points.
Meets – Student works hard to
build rapport with patients. We
have discussed the importance
of “reading the room” and
adjusting our approach to the
patient in front of us and I have
seen improvement in the few
short weeks he has been here.
This is a self-identified area of
improvement as well.
Meets – We have worked on
improving documentation and
writing a note as if the person
who reads it was not present in
the encounter. His
documentation is at the level I
would expect from his rotation
experiences. His written
communication is always
professional and succinct.
Meets – See midpoint
comments. Student also
appropriately assessed Kerendia
literature for a patient who was
unable to be on an ACE/ARB
or SGLT2 for
microalbuminuria.
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Practice Manager Domain MIDPOINT FINAL

Appropriately use common automated systems N/A N/A
to fulfill a medication order. (Example –
Automated dispensing cabinets, sterile
compounding systems, pill counting equipment)

Question Comments Question Comments

(Midpoint): (Final):

Section Weight: 0%

Self-Developer Domain MIDPOINT FINAL

Perform a self-evaluation to identify
professional strengths and weaknesses.
Question Comments Question Comments
(Midpoint): (Final):
Meets – As seen above, Student Meets – see midpoint
has been able to identify areas comments
for improvement and has
reported real growth since the
beginning of his rotation year.

Section Weight: 0%

Professionalism and Work

Ethic
Grading Scale: Consistently, Inconsistently,
Never MIDPOINT FINAL
Appearance exemplifies that of a professional Meets Meets
(i.e. dress, hygiene).

Question Comments Question Comments

(Midpoint): (Final):

The student is self-motivated and eager to Exceeds – Student is always Exceeds – see midpoint
learn. engaged, enthusiastic, and comments
focused! He takes great
initiative to jump into clinic,
Question Comments Question Comments more than most!
(Midpoint): (Final):

Demonstrates punctuality in attendance. Meets Meets

Question Comments Question Comments

(Midpoint): (Final):

Demonstrates dependability in all assigned
tasks and projects.
Question Comments Question Comments
Meets – Student was very well
prepared for his DM topic
discussion and rarely relied on
notes during the presentation.
Meets – Student is dependable,
and all work has been thorough
and complete. We did discuss
that it is beneficial to get a
rough draft to preceptors prior
 to the presentation for feedback
(Midpoint): (Final): and to ensure we are on the
right track and have the same
expectations.

The student is professional and ethical in Meets Meets

attitude and behavior.

Question Comments Question Comments

(Midpoint): (Final):

The student accepts constructive criticism and
appropriately modifies behavior.
Question Comments Question Comments
(Midpoint): (Final):
Meets Meets – Student has worked on
individualizing treatment plans
and on his approach in patient
visits. There has been
noticeable improvement.

Open Ended Feedback

Please enter comments as appropriate. MIDPOINT FINAL
Please list specific strengths of the student Student’s clinical knowledge is See midpoint!
noted during this rotation. solid. He makes guideline-
directed recommendations. He
takes initiative, has a great
Question Comments attitude, is engaged, and has
Question Comments
(Final): *Comment meaningful patient interactions.
(Midpoint):
Required Everyone has enjoyed having
him in their different clinic sites
and appreciates his
participation.

Please list specific areas needing improvement Student can continue to work as See midpoint comments.
which future preceptors should focus on during his communication style, as he
subsequent rotations. has identified. He can focus on
developing his motivational
interviewing skills and meeting
Question Comments patients where they are at. He
Question Comments
(Final): *Comment can also work on strengthening
(Midpoint):
Required
collaboration when working
with other providers. We will
continue focusing on creating
treatment plans that are
individualized based on patient-
specific factors (labs, income,
other comorbidities, etc.) and
will work on identifying
appropriate follow up windows.

What specific activities would you suggest for Student will begin leading Continue leading appointments
this student during future rotations which would patient appointments this next to find his flow and manage the
complement his or her experience(s) to date? week. I also think he will have unexpected situations that arise
good opportunity to continue to in patient care! Also continue

Question Comments
Question Comments
(Final): *Comment
(Midpoint):
Required
develop interprofessional on with motivational
relationships as he will return to interviewing and nonpharm
HF clinic next week. We will recommendations. Always a
also focus on nonpharm and spot for students to work on.
lifestyle modifications for
diabetes appointments, in
particular (lots of motivational
interviewing).

Section Weight: 0%

MIDPOINT Status
MIDPOINT Status: Student should receive a
ON TRACK grade if they are on track to
demonstrate proficiency and consistent
performance at or above expectations by the
end of their experience. Student should receive
a NOT ON TRACK grade if they are not on
track to demonstrate proficiency and consistent
performance at or above expectations by the
end of their experience, unethical (e.g.
consistent attendance/punctuality issues,
inappropriate language or communication). MIDPOINT FINAL
Based on the student's performance and the ON TRACK! Really appreciate PASS! Student has been
preceding criteria, recommend the student's Student’s flexibility, “can do” fantastic to have in clinic. He
MIDPOINT rotation grade. attitude, energy, and genuine brings energy and enthusiasm
interest in patient care. As to his interactions. He has a
noted by another pharmacist solid foundation of knowledge
Question Comments Question Comments “wish he was actively pursuing and the drive to keep pursuing
(Midpoint): (Final): amb care!” learning. Excited to see where
he goes! And thrilled for him
that he already knows his next
plans!

Section Weight: 100%

Recommended FINAL Grade MIDPOINT FINAL

for Rotation
FINAL Grade: Student should receive a PASS
grade if they are proficient and consistently
perform at or above expectations. The student
displays attributes that are consistent with
readiness to enter general practice. Student
should receive a NO PASS grade if they
perform below expectations consistently,
require significant improvement, and/or does
not display attributes consistent with readiness
to enter general practice. Please note areas in
need of improvement in Comment Box.

AUTOMATIC NO PASS:

 Breaches patient confidentiality or

knowingly violates policies of the site
 Does not meet requirements and
expectations outlined by the preceptor
  Displays skills, abilities, and/or
knowledge deficiencies that are a
concern for patient care
 Professional behavior is inappropriate
and/or unethical (e.g. consistent
attendance/punctuality issues,
inappropriate language or
communication)

Based on the student's performance and the PASS PASS

preceding criteria, recommend the student's
FINAL rotation grade.

Question Comments Question Comments

(Midpoint): (Final):

Additional Monitoring by OEE Recommended

If the student has received one or more “below expectations/inconsistently/never” or "Fail", please check which, if
any, of the following the Office of Experiential Education should monitor for the student.

Final
Midpoint


Professionalism
Professionalism


Time Management
Time Management


Communication
Communication



Referral to OEE for Performance Improvement Plan

If the student has received one or more “below expectations/inconsistently/never” or "Fail", please check which, if
any, of the following improvement plans should be developed for the student.

Final
Midpoint


Time Management Skills
Time Management Skills


Organizational Skills
 Organizational Skills


Communication
Communication


Drug Information Skills
Drug Information Skills


Therapeutics Drug Knowledge
Therapeutics Drug Knowledge



Therapeutic Knowledge Deficits

For students who received a no pass recommendation due to therapeutic knowledge deficits, please list the specific
therapeutic topics for review prior to restarting patient care experiences.

Comments (Midpoint): Comments (Final):